The Kings Fund considers current methods for embedding quality improvement in the NHS

Embedding a culture of quality improvement
The King’s Fund, November 2017

This paper from the King’s Fund considers the use of quality improvement methodologies in the NHS. Using interviews and focus groups with those engaged in these programmes, it suggests a number of key enablers to ensure the success of quality improvement approaches.

The paper begins by looking in more detail at what quality improvement approaches are. It states that they are “based on the principle of health care organisations and staff continuously trying to improve how they work and the quality of care and outcomes for patients”. Those employing these methods have indicated improvements in timeliness, time-savings, cost reductions, productivity and a reduced number of errors or mistakes. 

A small number of NHS organisations are currently embarking on “systematic, organisation-wide programmes” to embed continuous improvement. Five NHS trusts are currently involved with a partnership between NHS Improvement and the Virginia Mason Institute. The five-year programme aims to support five trusts to adopt a wide-range of quality improvement tools.

The report looks initially at issues the participants had considered before embarking on a quality improvement programme. It stresses the importance of having a clear rationale for pursuing this approach. Several participants identified specific patient safety incidents leading to a realisation that change was needed, with others focusing on more general performance pressures. The paper stresses the importance of ensuring that staff are ready for the changes involved, with a focus on the importance of staff engagement, as well as understanding the implications for leadership.

Key enablers for sustaining a quality improvement approach:

  • Developing and maintaining a new approach to leadership – leaders under these methodologies must become ‘managers of the system’ allowing staff to do their own problem solving and enhancing their sense of ownership.
  • Allocating adequate resources and time – staff need adequate time to dedicate to quality and safety activities and must be given time away from their day jobs for training and to pursue improvement.
  • Ensuring that patients, service users and their carers are central to the strategy – patients are said to “have a unique role to play in identifying quality problems” and coming up with solutions.
  • Maintaining staff engagement – the degree of cooperation and engagement between managers and staff is central to productivity. Good staff engagement can be driven by an engaged leadership, the use of ‘compacts’ with staff, empowering staff to make changes, giving staff adequate time to participate in improvement activities, sharing data on progress and ensuring “the feedback loop is closed”.
  • Committing to continuous improvement and fidelity to the method – these methods require active, committed leadership, with chief executive and board commitment considered essential. This is also a long-term commitment, not a ‘quick fix’ and needs to be considered as a permanent change.

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